Financial— Anne Walsh receives compensation from MedBridge for the production of this course. There are no other relevant financial relationships. Nonfinancial— No relevant nonfinancial relationship exists.
Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.
Anne Walsh, RN, MSN, APRN-BC, CWOCN, ACHPN
Anne Walsh, RN, MSN, APRN-BC, CWOCN, ACHPN has been a registered nurse for over 20 years and an NP for over 15 years and is currently working as a nurse practitioner for the Visiting Nurse Service of New York (VNSNY) hospice program. She provides wound and ostomy consults for hospice patients with complex wound and…Read full bio
1. What is Palliative Wound Care?
This chapter will introduce the concept of palliative wound care, which shifts the focus on wound symptom management versus wound healing, which may not always be possible in the individual with advanced disease. Palliative wound care is important, as wounds affect about a third of hospice patients. It seeks to relieve suffering and also to help establish realistic wound care expectations to decrease the frustration and possible blame when unrealistic expectations, such as wound healing, may not be possible. Furthermore, palliative wound care seeks to relieve the burden on caregivers by simplifying the wound care regimen so that more quality time is spent with the loved one and less on providing complicated wound care regimens that may be more burdensome than beneficial.
2. Common Wounds Seen at the End of Life and Wound and Peri-Wound Assessment
A comprehensive wound and peri-wound assessment is an important first step, as this will drive the treatment. With palliative wound care, this assessment will also include the patient and or/caregiver’s goals of care. And as noted in chapter 1, it is important to establish realistic goals of care. It is certainly okay to be hopeful that the wound will heal, but it is also important to be open and honest and “hope for the best, but prepare for the worst.”
3. Pressure Injury Stages and Interventions to Manage and Reduce the Risk of Developing Pressure Injuries
This chapter will cover proper staging of pressure injuries and interventions that can be used to both reduce the risk of pressure injury development to be used as part of the treatment plan. This is important, since as noted above, about a 1/3 of patients on hospice have wounds, with about 50% of these wounds being pressure-related. Accurate staging is an important part of the assessment of pressure injuries for accurate documentation, to tailor the treatment, and for possible cases involved in litigation.
4. Intact Eschar and the Frail Patient
This chapter will address the wounds with intact eschar. This is important as intact eschar serves as a protective shell, and opening this up in the frail individual with poor healing potential can lead to complications of infection and increased distressing symptoms such as odor, drainage, pain, bleeding, and increased caregiver burden.
5. Palliative Wound Treatment Options
This chapter will offer treatment options to address the wound symptoms. This is important to improve the patient and caregiver’s quality of life and to decrease the burden of wound care by simplifying the regimen. A series of case studies will be reviewed to apply the knowledge.